Will IM "keep more options open" in the upcoming future?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

sargon2123

Full Member
Joined
May 1, 2019
Messages
162
Reaction score
99
Given the leftward political direction to single payer for the US, and the recently uncertain future for multiple specialties (gas, rad onc, ophtho, EM), do you all think IM will keep more options open in case some event causes a huge portion of medicine to go under?
 
single payer is not happening. if anything it will just be a public option. trump is winning 2020 anyways so nothing to worry about for now.

For those of us in med school it’s not a matter of just the 2020 election but also what comes after that term. Med school + residency + etc means we have 5-8 more years before starting our career as an attending
 
For those of us in med school it’s not a matter of just the 2020 election but also what comes after that term. Med school + residency + etc means we have 5-8 more years before starting our career as an attending
I really don't see single payer happening in the US anytime within the next 10-20 years. 20+ years who knows, but for now I don't see it happening.
 
I really don't see single payer happening in the US anytime within the next 10-20 years. 20+ years who knows, but for now I don't see it happening.
Do you mind expanding just a tiny bit more? I feel like a lot of people whose job markets went downwards unexpectedly say this line. I imagine 20 years ago people who worked in malls or blockbuster couldn't see a lot of the changes happening this fast. Not trying to challenge you but I get anxious thinking that my hard work will be for nothing. I like learning the subject, I feel I would like patient care, but it would be a little bit sad to think I will make like 200k+ and then make 120k after 8 years of working harder than an average person. I know I'm not entitled to anything and that 120 will not make me poor, but it would just be sad to get walloped by some policy change after all of this..
 
Given the leftward political direction to single payer for the US, and the recently uncertain future for multiple specialties (gas, rad onc, ophtho, EM), do you all think IM will keep more options open in case some event causes a huge portion of medicine to go under?

What makes you think EM would go down specifically? It seems like the greater benefitter of everyone having insurance, now hospitals won't lose money on patients who don't/can't pay.
 
Do you mind expanding just a tiny bit more? I feel like a lot of people whose job markets went downwards unexpectedly say this line. I imagine 20 years ago people who worked in malls or blockbuster couldn't see a lot of the changes happening this fast. Not trying to challenge you but I get anxious thinking that my hard work will be for nothing. I like learning the subject, I feel I would like patient care, but it would be a little bit sad to think I will make like 200k+ and then make 120k after 8 years of working harder than an average person. I know I'm not entitled to anything and that 120 will not make me poor, but it would just be sad to get walloped by some policy change after all of this..

likely because the mid and late career physicians have the power and wealth to collectively stop providing care under a medicare-for-all system.
 
What is single payer and why would it hurt certain specialties?
 
Do you mind expanding just a tiny bit more? I feel like a lot of people whose job markets went downwards unexpectedly say this line. I imagine 20 years ago people who worked in malls or blockbuster couldn't see a lot of the changes happening this fast. Not trying to challenge you but I get anxious thinking that my hard work will be for nothing. I like learning the subject, I feel I would like patient care, but it would be a little bit sad to think I will make like 200k+ and then make 120k after 8 years of working harder than an average person. I know I'm not entitled to anything and that 120 will not make me poor, but it would just be sad to get walloped by some policy change after all of this..
Ya no problem. The US switching to a single payer system is absolutely something I myself and many of premed/med school friends have thought about. It would really suck, like you said, to go through all these years of training looking towards a 200k+ salary and then end up getting 100-120k. The reason I don't think it will happen in the next 10-20 years is for one, the government really sucks at agreeing over almost anything. I mean they have been arguing over a 20 billion dollar wall for the last few years, I don't think they could all come together and push through a multi trillion dollar healthcare plan though, at least not without years or decades of social and political support from the majority of players. Which plays into my second point that even if the Democratic Party had control of the house, senate, and president, there are still Dems that would vote against these bills, as they are not as left leaning as many of the most vocal Dems today. Not to mention that the supreme court will be controlled by conservatives for a while, whether they vote left or right can vary slightly, but this kind of system would be challenged in the supreme court. Another point is that there is, and will constantly be healthcare lobbying against this kind of system. The US spends over 3 trillion dollars a year on healthcare, thats a lot of money for a lot of people, and they are going to fight to keep all that money coming.

Also, this is the internet, you or anyone else are welcome to challenge any point I made, I'm not going to be offended or anything lol
 
likely because the mid and late career physicians have the power and wealth to collectively stop providing care under a medicare-for-all system.

I’m not saying you are wrong, but I would suggest that the most powerful influential groups that will be against Medicare for All will be the Insurance industry and the Pharmaceutical industry.

Insurance being an obvious loser if Medicare takes over, and pharmaceutical industry because they will be forced to lower prices due to the monopoly the government will have on payment.
 
Ya no problem. The US switching to a single payer system is absolutely something I myself and many of premed/med school friends have thought about. It would really suck, like you said, to go through all these years of training looking towards a 200k+ salary and then end up getting 100-120k. The reason I don't think it will happen in the next 10-20 years is for one, the government really sucks at agreeing over almost anything. I mean they have been arguing over a 20 billion dollar wall for the last few years, I don't think they could all come together and push through a multi trillion dollar healthcare plan though, at least not without years or decades of social and political support from the majority of players. Which plays into my second point that even if the Democratic Party had control of the house, senate, and president, there are still Dems that would vote against these bills, as they are not as left leaning as many of the most vocal Dems today. Not to mention that the supreme court will be controlled by conservatives for a while, whether they vote left or right can vary slightly, but this kind of system would be challenged in the supreme court. Another point is that there is, and will constantly be healthcare lobbying against this kind of system. The US spends over 3 trillion dollars a year on healthcare, thats a lot of money for a lot of people, and they are going to fight to keep all that money coming.

Also, this is the internet, you or anyone else are welcome to challenge any point I made, I'm not going to be offended or anything lol
yea I know just prefaced my q with that since some people don't answer if they think you're antagonizing them lmao. "google it then" and all that. I feel people with >300k debt would be super ****ed if a change that drastic occurred and the chance is definitely unlikely so I guess I'll turn a blind eye towards it and continue studying. Thanks
 
What is single payer and why would it hurt certain specialties?

Single payer is essentially Medicare for All. A government run insurance system funded by taxes and provided to everyone.

As for certain specialties being affected, low paying, primary care based specialities will most likely be the least affected financially, while things like neurosurgery, ortho etc would likely be drastically affected
 
What is single payer and why would it hurt certain specialties?
Its universal healthcare funded by tax payers. The gov would have a monopoly on the system and would pay whatever they want for services, so they would pay less, and doctors make less. Pretty much the doctors with higher salaries now, would have a larger pay cut. Except maybe plastic surgeons that only do non-insurance cosmetic work (boob jobs for days)
 
What makes you think EM would go down specifically? It seems like the greater benefitter of everyone having insurance, now hospitals won't lose money on patients who don't/can't pay.

CMG’s. It’s already happening in Texas and Florida from what I’ve seen in the EM forum
 
CMG’s. It’s already happening in Texas and Florida from what I’ve seen in the EM forum

CMG means corporate medical group, right? Wouldn't they gain more money because hospitals are being paid more, and disemburse them more. It doesn't seem like a medicare for all issue, it seems like an EM specialty issue independent of medicare for all.
 
Its universal healthcare funded by tax payers. The gov would have a monopoly on the system and would pay whatever they want for services, so they would pay less, and doctors make less. Pretty much the doctors with higher salaries now, would have a larger pay cut. Except maybe plastic surgeons that only do non-insurance cosmetic work (boob jobs for days)

This is something I’ve wondered about. Do other fields have this much variation in specialty-outcome when controlled for education level like medicine does? On one side you’ve got derm cash-only physicians living in big cities and then you’ve got FM physicians getting paid less than half and likely having to live in less desirable areas. I’m not trying to be dramatic here, but it seems like the residency match is now significantly more high stakes than even getting into *a* med school
 
CMG means corporate medical group, right? Wouldn't they gain more money because hospitals are being paid more, and disemburse them more. It doesn't seem like a medicare for all issue, it seems like an EM specialty issue independent of medicare for all.

I didn’t mean to imply it was a single-payer issue. I was just showing an example of how a high paying specialty can suddenly become not so high paying either in general or in decent areas to live
 
Its universal healthcare funded by tax payers. The gov would have a monopoly on the system and would pay whatever they want for services, so they would pay less, and doctors make less. Pretty much the doctors with higher salaries now, would have a larger pay cut. Except maybe plastic surgeons that only do non-insurance cosmetic work (boob jobs for days)
I feel like this is as likely to pass as free tuition and full student loan debt cancellation
 
This is something I’ve wondered about. Do other fields have this much variation in specialty-outcome when controlled for education level like medicine does? On one side you’ve got derm cash-only physicians living in big cities and then you’ve got FM physicians getting paid less than half and likely having to live in less desirable areas. I’m not trying to be dramatic here, but it seems like the residency match is now significantly more high stakes than even getting into *a* med school
I would say that the match is more high stakes than getting into a school, cause at that point you will most likely have 200k-300k+ in loans, so getting a job is kinda important.
 
"Prediction is very difficult, especially if it's about the future."
--Nils Bohr


Seriously tho, live your life, do what you enjoy. There is no way to know what the future holds or the direction the future may take. Make decisions based on the best information available today.

Even if single payer happens, there may be no drastic change in physician reimbursement considering physican reimbursement is not the driving factor of cost in the US. Look towards candian salaries if you want to see what it would look like.

Even if signle payor doesnt happen there are a billion ways in which reimbursement could change, supply and demand of physicans and specialties may change, fee for service may vanish. all of which would have very drastic impact on reimbursements of different specialties. We might live in a world where pcps make as much as Neurosurgeons.

Also if you had a crystal ball, i hope you would use it for stock picking and lottery numbers since thats a much more efficient use of your time with deep insights into the future.
 
I’m gonna bump my question: if single payer happens, does pursuing IM residency keep the most options open?
 
Even if single payer happens, there may be no drastic change in physician reimbursement considering physican reimbursement is not the driving factor of cost in the US. Look towards candian salaries if you want to see what it would look like.

I agree. No way to know for sure of course, but I feel like people are overestimating how much it would really affect salaries.

OP don't worry about it. Pick the path that makes getting up out of bed for work in the morning tolerable.
 
This is something I’ve wondered about. Do other fields have this much variation in specialty-outcome when controlled for education level like medicine does? On one side you’ve got derm cash-only physicians living in big cities and then you’ve got FM physicians getting paid less than half and likely having to live in less desirable areas. I’m not trying to be dramatic here, but it seems like the residency match is now significantly more high stakes than even getting into *a* med school

Okay. Being in FM doesn’t mean you’re poor and living in bad locations.

Maybe I am just a crazy person, but getting 200k a year would be more than enough for me (without debt taken into consideration). My parents combined made like 40k a year so i consider that a LOT.
 
"Prediction is very difficult, especially if it's about the future."
--Nils Bohr


Seriously tho, live your life, do what you enjoy. There is no way to know what the future holds or the direction the future may take. Make decisions based on the best information available today.

Even if single payer happens, there may be no drastic change in physician reimbursement considering physican reimbursement is not the driving factor of cost in the US. Look towards candian salaries if you want to see what it would look like.

Even if signle payor doesnt happen there are a billion ways in which reimbursement could change, supply and demand of physicans and specialties may change, fee for service may vanish. all of which would have very drastic impact on reimbursements of different specialties. We might live in a world where pcps make as much as Neurosurgeons.

Also if you had a crystal ball, i hope you would use it for stock picking and lottery numbers since thats a much more efficient use of your time with deep insights into the future.
Agreed. I think there's a lot of undo fear over this. In the long run, medicare for all saves money. The only people that should be worrying are those that are in insurance or in thr pharmacutical business
 
Agreed. I think there's a lot of undo fear over this. In the long run, medicare for all saves money. The only people that should be worrying are those that are in insurance or in thr pharmacutical business

And if compensation decreases and they do nothing about student debt. Otherwise, im all for medicare for all.

My school’s current problem with its hospital closing leaves the most vulnerable people (the uninsured especially) in dire straights. People should not be dying because they cannot afford care.
 
Okay. Being in FM doesn’t mean you’re poor and living in bad locations.

Maybe I am just a crazy person, but getting 200k a year would be more than enough for me (without debt taken into consideration). My parents combined made like 40k a year so i consider that a LOT.

Debt + Highly Skilled Work + High Tax Bracket + Wanting to live comfortably in a decent area = you’ll want more than 200k for sure.
 
Debt + Highly Skilled Work + High Tax Bracket + Wanting to live comfortably in a decent area = you’ll want more than 200k for sure.

I consider the philly suburbs a very decent area and nobody i know who makes that amount of money struggles to make ends meet around here. Depends on what kind of lifestyle you want though.
 
What about single-payer is going to cause a field to go under? Especially the ones you've listed? Until someone comes up with a magic pill to cure cataracts, optho isnt going anywhere. ED might be less busy with less people presenting to the ED without ED complaints because they have a primary care physician that they can follow with.

But of all the things that are going to shape medicine going forward, I really wouldn't be picking a specialty based on how you think single-payer is going to affect it.
 
It's not going to happen. The pushback will be too great to overcome. Most Americans will realize that single-payer is idiotic and it will end up just being something like a public option at most. It might drive prices down a little bit but not likely to make a dent in the grander scheme of things.
 
Most Americans will realize that single-payer is idiotic

Yeah this is seen with the polling that organizations do on the topic. If you just ask about "universal healthcare" then over 50% support it, but as soon as you add the qualifiers like "universal healthcare with an increase in taxes" (which would 100% happen) then public support plummets lol. People want the free stuff until they realize that "free" doesn't mean what they think it means.
 
Yeah this is seen with the polling that organizations do on the topic. If you just ask about "universal healthcare" then over 50% support it, but as soon as you add the qualifiers like "universal healthcare with an increase in taxes" (which would 100% happen) then public support plummets lol. People want the free stuff until they realize that "free" doesn't mean what they think it means.
It's not going to happen. The pushback will be too great to overcome. Most Americans will realize that single-payer is idiotic and it will end up just being something like a public option at most. It might drive prices down a little bit but not likely to make a dent in the grander scheme of things.
Medicare for all has been show to cut down excessive healthcare costs. No one is taking away your salary.
 
Okay. Being in FM doesn’t mean you’re poor and living in bad locations.

Maybe I am just a crazy person, but getting 200k a year would be more than enough for me (without debt taken into consideration). My parents combined made like 40k a year so i consider that a LOT.
That is how other specialties look at us (FM, IM) in medicine... Look at the poor IM/FM guy... his house is only 3000 sqft and he driving just an Acura. They feel pity for us and I don't blame them
 
That is how other specialties look at us (FM, IM) in medicine... Look at the poor IM/FM guy... his house is only 3000 sqft and he driving just an Acura. They feel pity for us and I don't blame them

Lol that doesnt sound bad at all
 
That is how other specialties look at us (FM, IM) in medicine... Look at the poor IM/FM guy... his house is only 3000 sqft and he driving just an Acura. They feel pity for us and I don't blame them
Only 3000 sqft!?!?? My garage better be at least 3000 sqft *sarcasm*
 
I'm not sure I understand the point of the question since we don't know who's going to win the 2020 election and what will actually happen afterwards. It's basically meaningless to try to predict the future since we don't know what's going to happen.
 
I'm not sure I understand the point of the question since we don't know who's going to win the 2020 election and what will actually happen afterwards. It's basically meaningless to try to predict the future since we don't know what's going to happen.

We know that healthcare has been moving leftward, both in action and dialogue, in 2010 onward. I disagree with ignoring certain future trends. You can’t predict everything, but you should plan for a few things.
 
To clarify the OP, I named specialties as an example of unexpected downturns, not as an example of single payer rearing an ugly head
 
Debt + Highly Skilled Work + High Tax Bracket + Wanting to live comfortably in a decent area = you’ll want more than 200k for sure.

What in the world is your definition of "comfortably". My situation wasn't quite as extreme as ciestar, but my parents make <80k combined and we've lived comfortably in a great area in Los Angeles for as long as I could remember. Making nearly triple their salary on my own blows my mind. Not every family who lives in Los Angeles, San Diego, San Francisco, Boston, New York City have STEM occupations, and the ones that don't aren't all on welfare or struggling to make ends meet.
Unless you plan on going on multiple vacations a year, want the biggest house and Teslas for every family member, want your spouse to be a stay-at-home wife/husband, and absolutely refuse to take on any bit of mortgage on your house, you can live comfortably with any physician's salary.

No offense because everyone lives their own lives, but I feel like you can really tell what bracket posters were raised under with posts like these.
 
What in the world is your definition of "comfortably". My situation wasn't quite as extreme as ciestar, but my parents make <80k combined and we've lived comfortably in a great area in Los Angeles for as long as I could remember. Making nearly triple their salary on my own blows my mind. Not every family who lives in Los Angeles, San Diego, San Francisco, Boston, New York City have STEM occupations, and the ones that don't aren't all on welfare or struggling to make ends meet.
Unless you plan on going on multiple vacations a year, want the biggest house and Teslas for every family member, want your spouse to be a stay-at-home wife/husband, and absolutely refuse to take on any bit of mortgage on your house, you can live comfortably with any physician's salary.

No offense because everyone lives their own lives, but I feel like you can really tell what bracket posters were raised under with posts like these.

Even now, my husband and I vacation funded by credit card points.

I do not strive to have the best everything. I know now in someways what i want in the future and that doesn’t include brand new cars, expensive cars, a huge house...

If we have kids they could go to public school. If we’re in the same district my husband went to he is more than comfortable with that decision.
 
ED might be less busy with less people presenting to the ED without ED complaints because they have a primary care physician that they can follow with.

As a Canadian, I would be shocked to see fewer people presenting to an ED because of non-ED complaints. One of the biggest strains on the healthcare system in Canada is the inappropriate utilization of ED resources. The expectation of free healthcare sends people in droves to the ED, where they are completely okay with waiting hours (after being triaged with something essentially benign) before being seen by a physician who looks like they have not stopped since they arrived on shift. Especially if it takes any longer than a few days to be seen by your GP.
 
Name one (1) thing that has gotten cheaper once the government has gotten involved

we have a dysfunctional government because one half of the political spectrum is constantly trying to handicap the governing process. So don't look at our government as an example (that said, the ACA blunted several years of inflationary growth on healthcare costs, so there's your example). Abroad, universal type healthcare plans do decrease cost and still maintain a high standard of living for physicians. M4A is probably too extreme, but the ACA can be improved in multiple ways that would expand coverage and reduce costs.

And fwiw, the savings a universal plan would bring to the average family is immense. Currently, many families pay >800/month in coverage for a family insurance plan after their employer picks up their tab. On top of that, most plans have a 2500 deductible before they start paying anything (usually 80/20 but can go up to the 100%). In real money terms, the average family is paying ~12k before insurance helps out at all (equivalent to ~15-6k pre-tax). No tax scheme would close to that much in order to provide universal medical care to everyone. I personally support something like the public option for individuals or families to buy into Medicare rather than full-on abolishing private insurance, but let's not pretend that private insurance is a universal good for everyone. Back in the early 00s. my father hit his lifetime cap after a Whipple with complications requiring a 44 day ICU stay and had to forgo treatment for his pancreatic cancer lest he bankrupt our family. Those were the kinds of choices patients were making just 15 years ago.
 
I’m gonna bump my question: if single payer happens, does pursuing IM residency keep the most options open?
Nothing is safe regardless of whether or not this gets passed. With the stroke of a pen, any fields bread and butter could go away over night. Conversely, a new innovation could randomly increase the earning potential of another field. There’s no way to know and anyone who pretends that they do have some insight into the future of a field they’ve never practiced in is probably a fool. Practicing physicians get blindsided by random changes to the way they’re expected to make money so a forum full of premeds and med students definitely won’t know.
 
Maybe it’s just me, but if Medicare for all passes, I’ll probably just leave the country. The only thing that makes me want to practice in the US versus anywhere else is the high pay. Take that away and I might as well travel the globe. Sounds kinda fun.
 
Maybe it’s just me, but if Medicare for all passes, I’ll probably just leave the country. The only thing that makes me want to practice in the US versus anywhere else is the high pay. Take that away and I might as well travel the globe. Sounds kinda fun.
I honestly think you're over-reacting with medicare for all. Like other posters have stated, it saves money in the long run, cuts down on unnecessary paperwork. Not one single politician is advocating to cut physician salaries. Try different news sources every now and again.
 
I honestly think you're over-reacting with medicare for all. Like other posters have stated, it saves money in the long run, cuts down on unnecessary paperwork. Not one single politician is advocating to cut physician salaries. Try different news sources every now and again.
Duh. Bc that’s not popular. But the government always reimburses lower than private. You think the government will take over all of it and start reimbursing at a higher rate overall to compensate for the loss we’d otherwise take? That’s a special kind of naïveté.

Btw, I’m very liberal for the most part but this is just common sense. If they’re the only ones paying, then there’s no incentive to pay us well. That’s not Fox News fear mongering. That’s just Econ 101
 
Have fun idiot, don't let the door hit you on way out.
Super cool post. Your sdn cred is envied by all and everyone thinks you’re a big deal.

Jokes aside, why would it be idiotic to practice in another country if the pay is more or less the same and I’d enjoy living elsewhere?
 
Duh. Bc that’s not popular. But the government always reimburses lower than private. You think the government will take over all of it and start reimbursing at a higher rate overall to compensate for the loss we’d otherwise take? That’s a special kind of naïveté.

Btw, I’m very liberal for the most part but this is just common sense. If they’re the only ones paying, then there’s no incentive to pay us well. That’s not Fox News fear mongering. That’s just Econ 101
There's a very good interview online about this that touches on this particular topic. I suggest you look at it, I believe it was through the young turks.

 
Top